From the Guidelines
Genital herpes is caused by herpes simplex virus (HSV), primarily HSV-2 but also HSV-1, which establishes lifelong infection through a specific pathophysiological process. The virus initially enters the body through breaks in the skin or mucous membranes during sexual contact with an infected person. After entry, HSV replicates in epithelial cells, causing the characteristic painful vesicles and ulcers. The virus then travels via sensory nerve endings to dorsal root ganglia (typically the sacral ganglia for genital herpes), where it establishes latency. During this latent phase, the viral genome persists in neurons without active replication. Periodic reactivation occurs when triggers such as stress, illness, immunosuppression, or hormonal changes cause the virus to replicate and travel back down the nerve to the skin surface, resulting in recurrent outbreaks. These recurrences may be symptomatic or asymptomatic, with viral shedding occurring in both cases. The immune system cannot eliminate the latent virus, explaining why herpes remains a chronic, incurable infection despite antiviral medications like acyclovir, valacyclovir, and famciclovir being effective at reducing symptoms and viral shedding during active episodes.
Key Points
- The primary cause of genital herpes is HSV-2, but HSV-1 can also be responsible 1.
- The virus enters the body through breaks in the skin or mucous membranes during sexual contact with an infected person.
- After entry, HSV replicates in epithelial cells, causing painful vesicles and ulcers.
- The virus establishes latency in dorsal root ganglia, where it persists without active replication.
- Periodic reactivation occurs due to various triggers, resulting in recurrent outbreaks.
Pathophysiology
The pathophysiological process of genital herpes involves the initial infection of epithelial cells, followed by the establishment of latency in dorsal root ganglia. The virus can reactivate periodically, causing recurrent outbreaks. This process is supported by studies such as 1, which discusses the management of genital herpes and the importance of antiviral therapy and counseling.
Management
The management of genital herpes includes antiviral therapy and counseling on the natural history of infection, risk for sexual and perinatal transmission, and methods to prevent further transmission 1. Antiviral medications like acyclovir, valacyclovir, and famciclovir can reduce symptoms and viral shedding during active episodes, but they do not eradicate the latent virus.
From the Research
Pathophysiology of Genital Herpes
The pathophysiology of genital herpes involves the infection of genital herpes simplex virus (HSV), primarily type 2 (HSV-2), but also type 1 (HSV-1) 2. The virus enters the host through mucous membranes or broken skin, leading to primary infection, which can be symptomatic or asymptomatic 3.
Primary Infection
Primary genital herpes is characterized by systemic signs and symptoms, such as painful genital lesions, fever, and malaise 4. The primary infection can also lead to complications, including cervical dysplasia and neonatal herpes 4.
Recurrent Infections
Recurrent infections are typically milder than primary infections, with fewer systemic symptoms and less frequent complications 4. However, recurrent infections can still cause significant morbidity, including pain, discomfort, and psychological distress 5.
Transmission
Transmission of genital herpes can occur through asymptomatic viral shedding, as well as through contact with active lesions 3. The virus can be shed from the genital area, even in the absence of visible lesions, making it difficult to prevent transmission 3.
Molecular Mechanisms
The molecular mechanisms of genital herpes infection involve the interaction of the virus with host cells, including the binding of viral entry receptors, such as nectin-1 and HVEM, and the subversion of innate immune mechanisms, such as autophagy 2.
Key Points
- Genital herpes is a sexually transmitted infection caused by HSV-2 or HSV-1 2
- Primary infection can be symptomatic or asymptomatic, and can lead to complications 4
- Recurrent infections are typically milder, but can still cause significant morbidity 5
- Transmission can occur through asymptomatic viral shedding or contact with active lesions 3
- Molecular mechanisms involve the interaction of the virus with host cells and the subversion of innate immune mechanisms 2
Treatment and Prevention
While there is no cure for genital herpes, antiviral medications, such as valacyclovir, acyclovir, and famciclovir, can reduce symptoms and prevent transmission 5, 6. Suppressive therapy can also be effective in preventing symptomatic recurrences 6. However, more research is needed to develop effective vaccines and prophylactics to prevent genital herpes infection 2.